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Common Cause and Lokniti Programme of the Centre for the Study of Developing Societies (CSDS), launched India’s first Status of Policing in India Report (SPIR 2018) at the India Habitat Centre on May 9.

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A Model Living Will

ADVANCE MEDICAL DIRECTIVE

A First Draft of a Model Living Will

Disclaimer: This is a draft Advance Medical Directive (AMD) prepared on the basis of what we understood from the Supreme Court Judgment. It is meant to be a first draft and indicative in nature. We strongly recommend seeking sound legal opinion before writing or executing an actual Living Will.

As per the Supreme Court of India’s judgment dated March 9, 2018, the following Advance Medical Directive has been executed by me to lay down clear and specific instructions during the course of my treatment, as well as to strengthen the mind of the treating doctors that they are acting in a lawful manner.

I ___(name)__ am an adult of a sound and healthy state of mind and in a position to communicate, relate and comprehend the purpose and consequences of executing this document.

This AMD has been voluntarily executed without any coercion or inducement or compulsion and after having full knowledge or information.

I certify that this AMD has the characteristics of an informed consent given without any undue influence or constraint.

The purpose of this AMD in writing is to clearly specify the situations when medical treatment, having the effect of delaying the process of my death may be withdrawn or when no specific medical treatment is to be provided. This covers treatments, which if given, may cause me pain, anguish and suffering and further put me in a state of indignity.

In case the situation so arises that I become terminally ill or am reduced to a persistent vegetative state I may be permitted to accelerate the process of natural death which would have already commenced.

If at any time, I reach the stage of terminal illness, and go into a coma with no reasonable expectation of regaining consciousness, or reach a persistent vegetative stage with no reasonable expectation of regaining significant cognitive functioning, or have a disease state from which I have no reasonable expectation of coming back to a life with reasonable quality of life, I should be deemed to decline to receive life-sustaining treatment.

I request that this ‘AMD’ should be honoured by my family members and physicians as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences of such refusal.

In addition, and as a supplementary alternative, I hereby appoint Mr./Mrs. ________ who, in the event of my becoming incapable of taking decision at the relevant time, is hereby authorised to give consent to refuse or withdraw medical treatment in a manner consistent with this AMD.

I may at any time revoke these specific terms/instructions spelt out absolutely clearly and unambiguously by me in this AMD.

I have understood fully the consequences of executing this AMD.

This AMD shall not be applicable to the treatment in question if there are reasonable grounds for believing that circumstances existed which I did not anticipate at the time of the AMD and which would have affected my decision had I anticipated them.

WITNESS STATEMENT

I declare that the person who signed or acknowledged this document is personally known to me, that he/she signed or acknowledged this Living Will Declaration in my presence, and that he/she appears to be of sound mind and under no duress, fraud, or undue influence.

______________________ ________________________ First Witness Signature Second Witness Signature ______________________ ________________________ First Witness Full Name Second Witness Full Name ______________________ ________________________ ______________________ ________________________ First Witness Address Second Witness Address

In the event that I execute more than one valid AMD my most recently signed AMD should be considered as the last expression of my wishes and should be given effect to.

As per the directions of the Hon’ble Supreme Court this AMD has been signed by me in the presence of two independent attesting witnesses, and countersigned by the jurisdictional Judicial Magistrate of First Class (JMFC) so designated by the concerned District Judge.

I understand the full importance of this AMD and am fully competent to make it.

Conditions to be followed for implementation of the AMD:

  1. The witnesses and the jurisdictional JMFC shall record their satisfaction that the document has been executed voluntarily and without any coercion or inducement or compulsion and with full understanding of all the relevant information and consequences.
  2. The JMFC shall preserve one copy of the document in his office, in addition to keeping it in digital format.
  3. The JMFC shall forward one copy of the document to the Registry of the jurisdictional District Court for being preserved. Additionally, the Registry of the District Judge shall retain the document in digital format.
  4. The JMFC shall cause to inform the immediate family members of the executor, if not present at the time of execution, and make them aware about the execution of the document.
  5. A copy shall be handed over to the competent officer of the local Government or the Municipal Corporation or Municipality or Panchayat, as the case may be. The aforesaid authorities shall nominate a competent official in that regard who shall be the custodian of the said document
  6. The JMFC shall cause to handover copy of the AMD to the family physician, if any.
  7. In the event the executor becomes terminally ill and is undergoing prolonged medical treatment with no hope of recovery and cure of the ailment, the treating physician, when made aware about the Advance Directive, shall ascertain the genuineness and authenticity thereof from the jurisdictional JMFC before acting upon the same.
  8. The instructions in the document must be given due weight by the doctors. However, it should be given effect to only after being fully satisfied that the executor is terminally ill and is undergoing prolonged treatment or is surviving on life support and that the illness of the executor is incurable or there is no hope of him/her being cured.
  9. If the physician treating the patient (executor of the document) is satisfied that the instructions given in the document need to be acted upon, he shall inform the executor or his guardian/close relative, as the case may be, about the nature of illness, the availability of medical care, the consequences of alternative forms of treatment as well as the consequences of remaining untreated. He must also ensure that he believes on reasonable grounds that the person in question understands the information provided, has cogitated over the options and has come to a firm view that the option of withdrawal or refusal of medical treatment is the best choice.
  10. The physician/hospital where the executor has been admitted for medical treatment shall then constitute a Hospital Medical Board (HMB). It should consist of the Head of the treating Department (HOD) and at least three experts from the fields of general medicine, cardiology, neurology, nephrology, psychiatry or oncology, with experience in critical care and with overall standing in the medical profession of at least 20 years. The Board, in turn, shall visit the patient in the presence of his guardian/close relative and form an opinion whether to certify or not to certify carrying out the instructions of withdrawal or refusal of further medical treatment. This decision shall be regarded as a preliminary opinion.
  11. After the confirmatory preliminary opinion of HMB, the jurisdictional collector shall be informed, who in turn shall immediately constitute another Medical Board. This Board will have the Chief District Medical Officer of the concerned district as the Chairman, instead of the HOD. It shall jointly visit the hospital where the patient is admitted and if the members concur with the initial decision of the HMB, they may endorse the certificate to carry out the instructions given in the AMD.
  12. The Board constituted by the Collector must beforehand ascertain the wishes of the executor and determine if he is in a position to communicate as well as capable of understanding the consequences of withdrawal of medical treatment. In the event the executor is incapable of taking decision or develops impaired decision making capacity, another course of action needs to be taken. Then the consent of the guardian nominated by the executor in the AMD should be obtained regarding refusal or withdrawal of medical treatment to the executor to the extent of and consistent with the clear instructions given in the AMD.
  13. The Chairman of the Medical Board nominated by the Collector, shall convey the decision of the Board to the jurisdictional JMFC before giving effect to the decision to withdraw the medical treatment administered to the executor. The JMFC shall visit the patient at the earliest and, after examining all aspects, authorise the implementation of the decision of the Board.
  14. It will be open to the executor to revoke the document at any stage before it is acted upon and implemented.

Euthanasia: Concerns and Considerations

“This Court has to consider euthanasia and its impact ‘not only at an individual level’, but also at the ‘institutional, governmental and societal levels’. The impact has to be analysed not only in the context of the present era, but has to be contemplated for the future as well. The judge is not a soothsayer. Nor does the law have predictive tools at its command which can approximate those available to a scientist. Constitutional principle must have an abiding value. It can have that value if it is firmly grounded in the distilled experience of the past, is flexible to accommodate the concerns of the present and allows room for the unforeseeable future. The possibility of the abuse of euthanasia and the effect that legalising euthanasia would have on intangible societal fabrics and institutions is of utmost concern.” --- Justice Chandrachud.


 

April-June, 2018